Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia.
Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
J Epidemiol Community Health. 2019 Dec;73(12):1078-1086. doi: 10.1136/jech-2019-212282. Epub 2019 Oct 5.
Early childhood interventions are critical for reducing child health and development inequities. While most research focuses on the efficacy of single interventions, combining multiple evidence-based strategies over the early years of a child's life may yield greater impact. This study examined the association between exposure to a combination of five evidence-based services from 0 to 5 years on children's reading at 8-9 years.
Data from the nationally representative birth cohort (n=5107) of the Longitudinal Study of Australian Children were utilised. Risk and exposure measures across five services from 0 to 5 years were assessed: antenatal care, nurse home-visiting, early childhood education and care, parenting programme and the early years of school. Children's reading at 8-9 years was measured using a standardised direct assessment. Linear regression analyses examined the cumulative effect of five services on reading. Interaction terms were examined to determine if the relationship differed as a function of level of disadvantage.
A cumulative benefit effect of participation in more services and a cumulative risk effect when exposed to more risks was found. Each additional service that the child attended was associated with an increase in reading scores (b=9.16, 95% CI=5.58 to 12.75). Conversely, each additional risk that the child was exposed to was associated with a decrease in reading skills (b=-14.03, 95% CI=-16.61 to -11.44). Effects were similar for disadvantaged and non-disadvantaged children.
This study supports the potential value of 'stacking' early interventions across the early years of a child's life to maximise impacts on child outcomes.
儿童早期干预对于减少儿童健康和发展方面的不平等至关重要。虽然大多数研究都集中在单一干预措施的效果上,但在儿童生命的早期将多种基于证据的策略结合起来可能会产生更大的影响。本研究考察了从 0 岁到 5 岁期间接触五种基于证据的服务组合对 8-9 岁儿童阅读能力的影响。
本研究使用了全国代表性的澳大利亚儿童纵向研究(n=5107)的出生队列数据。从 0 岁到 5 岁评估了五种服务的风险和暴露措施:产前保健、护士家访、幼儿教育和保育、育儿计划和幼儿期。8-9 岁儿童的阅读能力采用标准化直接评估进行测量。线性回归分析考察了五种服务对阅读能力的累积效应。检验了交互项,以确定这种关系是否因劣势程度的不同而有所不同。
研究发现,参与更多服务有累积效益,而暴露于更多风险则有累积风险效应。儿童每参加一项额外的服务,阅读分数就会增加(b=9.16,95%CI=5.58 至 12.75)。相反,儿童每多暴露一个风险,阅读技能就会下降(b=-14.03,95%CI=-16.61 至-11.44)。对于劣势和非劣势儿童,效果相似。
本研究支持在儿童生命的早期将早期干预措施“叠加”以最大限度地提高儿童结果的潜在价值。